The Problem with Intervention

Humans want to intervene. It is in our nature. We see a problem, real or imagined, and we want to help. There are many perversions of this tendancy (e.g. “if I help out, I’ll be making myself look really good…”), but deep down, most people are trying to do the right thing. But any intervention has consequences. Often, that is exactly why we are intervening. If we see a child fall in a lake, we intervene so that the child may live. That is a good thing. If we are placing ourselves at risk, then it is a heroic action as well.

I intervene as a physician on a daily basis. Personally, I actively try not to intervene as much as possible. The human body is amazingly adapted to heal itself, but unfortunately, as a whole and not considering accidental injury, we humans make so many unhealthy choices and live such unhealthy lives, that we are severely limiting our body’s chances of healing itself. Sometimes I end up having to choose the lesser of two evils in deciding how to manage a medical problem. That is not by my choice. It is the patient who ultimately decides to do, or not do, something that will improve their health. Their history of action, or inaction, is often what brings them to my office. The course of action has consequences. Hopefully there are only good consequences, but sometimes there are negative consequences. And sometimes, there are consequences we never even considered. This is what I want to delve more into today. Let me start with a few examples:

Example 1: C-sectionsI have delivered my share of babies (actually, the mother delivered the baby. I was just there to catch!), and I have assisted in many cesarean section deliveries. Most of these C-section deliveries were needed… the baby was doing very poorly, the mother had medical problems and she could not have a vaginal delivery, the mother was in labor for days (literally) and could push no more, the baby was too big to fit through the birth canal… these are all legitimate reasons. Yes, there are way too many c-sections in general. I saw one report which stated that most unplanned C-sections are done on Fridays, indicating that the doctor didn’t want to ruin their weekend (I am still trying to verify this). Many physicians would rather deliver a healthy baby via c-section than risk the chance of something really bad happening to the baby or mother. This may be out of fear for their patients or fear of lawsuits, but the result is the same. Additionally, we have also lost many of the skilled midwives who would/could spend hours and hours with one patient for a vaginal delivery; many of the patients who could potentially have delivered with a midwife years ago now have c-sections. When I lived in Turkey, one Turkish obstetrician told me that about 80% of insured women have c-sections; it was a sign of status (there were a few other reasons that I will not get into today). That is incredible.

What is the unintended consequence of increased C-section rates?
If we would go back 100 years only, many of these mothers and babies would have died. My wife is one of these women (that is my daughter in the photo above!). She has a narrow birth canal, and our big-headed babies are just not going to be delivered without a C-section. Due to the advancement of obstetrics and surgery, the doctors were able to intervene and save the life of my wife and our children. But the result is that my daughters are much more likely to need a C-section if and when they have a baby of their own, and my sons are more likely to have daughters that will have narrow birth canals and require C-sections as well. All my children are more likely to have children with big heads! While I am insurmountably thankful for my wife and children’s health and well-being, I have to acknowledge that fact that we have bypassed natural selection. We cheated, so to speak. The more people do this, the more dependant humans, as a whole, will become on C-sections. While it is unlikely that women will ever stop having vaginal deliveries, I firmly believe that the percentage of childen born via cesarean section is going to steadily increase as time goes on.

HIV virus in a scanning electron microscopy image.

Example 2: HIV treatment
I spent a month working in Nigeria at a free HIV mission hospital a number of years ago. I was able to meet an amazing group of people who are saving and changing lives on a daily basis, and for a short time, I was a part of that. I would meet someone on almost a daily basis who would tell me (usually through a Hausa-English translator) how they had wasted away and were days from death. Then the providers at this clinic gave medications that brought the patient back from the brink. Now these patients were living on “borrowed time”. Anyone who has been afflicted with this terrible disease knows that HIV has no qualms about infecting “good” people, or “innocent” people, or children. It is a disease, a fatal one at that. Treating HIV-positive patients is a good thing. Period. Don’t misunderstand my next paragraph. I think we should continue to treat HIV-positive patients, and we should never stop looking for a cure.

What is the unintended consequence of treating HIV-positive patients?
When a person has HIV, they are contagious. They can be careful. They can be “safe”. But the fact remains, they have the ability to spread this disease to another person. Despite what is occasionally reported in the media, this is almost never a malicious act. It is a sad reality. Before medications were invented to treat HIV, an infected patient had a much shorter life expectancy. HIV does not kill as fast as the flu and rarely as fast as most cancers, but the result is a significantly shorter life. But with modern HIV medications, an HIV-positive patient has the ability to live a drastically longer life. These medicines do decrease their contagiousness, but it doesn’t bring it down to zero. The result is that an HIV-positive person now has an increased ability to spread the disease, potentially for decades more than they would have if these medicines were not available. Again, this doesn’t mean we should not treat these patients, but it is an example of an intervention having an unforseen consequence.

American Chestnut Trees before the blight and government intervention.

Example 3: Chestnut blight
Before 1900, there were an estimated four billion Chestnut trees in North America. Some of these trees were over 100 feet (30 meters) tall and over 10 feet (3 meters) in diameter! Then a fungus arrived from Asia dubbed Chestnut Blight, Cryphonectria parasitica. The Asian Chestnut trees were able to live with the fungus, but the American trees were not. The U.S. acted as quickly as it could to try and eradicate the disease, but all attempts failed. Within 40 years the Chestnut population was devastated.

What was the unintended consequence of trying to eradicate Chestnut Blight?
Many people are unaware that in an attempt to stop the spread of the disease, millions and millions of uninfected trees were chopped down. Once one Chestnut tree in one area was found to have blight, all the surrounding trees were logged. There is a decent chance that one or more of these millions of healthy trees had a natural ability to live with the blight, i.e. they were naturally immune. But we chopped them all down, so we will never know. In addition, these trees (healthy and infected) were sawn into lumber and shipped all over the country spreading the disease even faster.

I’ll also add that the government did not learn their lesson. Not too long ago (January 2000), South Florida was introduced (again!) to Citrus Canker, a bacteria (Xanthomonas axonopodis) which significantly weakens citrus trees and greatly reduces fruit production. This scared the orange industry in Florida. The decision was made to eradicate all citrus trees within a certain distance of an infected tree. An untold number of citrus trees were lost due to this mandate, including the ones in my parent’s backyard… as a child, I probably spent the cumulative equivalent of well over a month straight in those orange, grapefruit, and tangelo trees, and now they are gone. Six years after the eradication campaign began, with no surprise to any student of history, the Florida Department of Agriculture deemed the eradication effort infeasible.

Artificial insemination of a virgin queen honeybee… not quite a natural process.

Example 4: Modern Bee Husbandry
Honeybees are amazing creatures. I can’t wait to get my first hive. Now, if I followed the modern commercial method, this is what I woud do (please excuse my generalities as I have never managed a commercial honey company). I would purchase all my hives and equipment first. I would receive my queens and initial bees via mail for each hive. The queens would already be mated and ready to lay eggs. Once the hives were established, I would move the hives to an area that had a lot of flowers blooming, like an apple orchard. Then, when the apple flowering started to slow down, I would load up the hives, and drive to another location of flowering. I would do this through the flowering season, moving many times all over the state and sometimes the country. At the end of the season, and maybe even during the season, I would take out some of the honey laden combs. The caps would be removed from the combs, and they would be spun to extract all the honey. The empty combs would be placed back in the hive. During the colder months, the bees would go into hibernation back at my base of operations. If I thought I took too much honey from them, or even as a matter of policy, I would provide some sugar water or fondant or high-fructose corn syrup for them to make it through the Winter. During the growing season, if one hive was not doing very well, I would combine it with another hive that was not doing to well, resulting in one stronger bee colony. I would probably replace my queens every year. I would get a lot of honey. I would do a lot of work.

What is the unintended consequence of raising honeybees in the modern method?The modern method of beekeeping is far removed from how honeybees normally live. Commercially, a young, virgin queen bee is artificially inseminated with sperm from a number of crushed (i.e. killed) male bees, known as drones. In nature, a virgin queen would go on a mating flight; only the quickest drones would be able to mate with the queen – we’ve have a loss of optimal genetics with this method. Next, commercial bees are moved all over the place. In nature, bees don’t travel over the country. They stay in one spot, and occasionally the hive splits (swarms), but they really don’t travel very far. By moving all over the place, we’ve lost adaptations to local conditions with this method. In addition, commercial bees are “fed” from the same type of flower for weeks at a time. In nature, bees forage from a wide variety of ever changing plants – we’ve probably lost nutrition quality for the bees with this method. Also, commercial bees are exposed to all the chemicals sprayed on the fields they have been moved to – there is growing evidence that some of these chemicals are causing colony colapse disorder. Modern-raised bees use combs that have been used over and over again for years – the wax accumulates toxins and pests and disease with this method. Modern-raised bees are robbed of their high-quality honey and given unhealthy alternatives – these can cause the bees to become sick, and they also likely result in a less healthy colony. Commercial colonies are combined when they are not doing well. In nature, if a colony is not doing well, it dies. There is probably a good reason for this; maybe they are infected or sick or not good foragers or any other number of problems. By combining weak colonies, we are propping up and propagating weak colonies resulting in weaker bees for the future. Modern-raised colonies are requeened every season. In nature, colonies requeen from within, when needed. Requeening the colony results in additional loss of adaptation to local conditions.

In conclusion, I want to say that I know some intervention is needed. Whenever we develop a Permaculture site, intervention is required. But we need to open our eyes to the bigger picture. We need to understand that there are consequences to our actions. Sometimes the consequences are good. Sometimes they are bad. If we follow the Ethics of Permaculture, and if we use small and slow solutions when possible, we will greatly reduce the negative impact of our interventions.

8 Comments

Today’s solution becomes tomorrow’s problem. And these are relatively simple, predictable consequences. Take urban renewal: the stated goal is to bring the core of a city back to prosperity. This, of course, raises property values, which drives the working poor people out of the core of the city to the less expensive and less desirable areas in the outer suburbs. But these people are needed to work the service level jobs that are in the central core of the city – baristas, wait staff, janitors, etc. – and now all of these people have to make their way into the city every day.

So the solution to an impoverished downtown core, in this case, results in a working-class diaspora, further sprawl (as the land farthest from the city is probably cheapest to develop), greater strain on transportation infrastructure in and around the city, and worse pollution. This is not to mention that all the time people spend travelling is essentially wasted time, so now they have less time to cook and spend with their families,resulting in less healthy children who do worse in school (their parents aren’t home early enough to help them with school work) *DEEP BREATH IN* further exacerbating the cycle of poverty and producing an outer ring of impoverished suburbs with all the same problems as the urban core!

~ I think this ties into your keenly accurate article “what is holding permaculture back” with the point about moderate adoption of new practices. In my own life I notice zeal over what seems to be an easy solution (say fighting invasive plants) tends to either fade away after a period of time, or else bends and is remolded many times into something much different (currently planting many invasives as land healers, maybe I will regret it!). I attempt to hold back and try to look on matters without judgement, but oftentimes life doesn’t slow down to this extent, you cannot find objectivity – you must merely try to stand behind your decision and learn from it. We’re all moving forward as a ship (the galactica!) and these times call for massive empathy and forgiveness towards all sides and for our own mistakes. When everybody is on a different level of growth out of different microcultures, it’s quite hard to forge a path forward.

~ Permaculture will truly start to catch when the buzz it creates recedes – when the principles are referenced unspoken as a combination of common sense and individual vision. From just one aspect that I’m familiar with, gardening and agriculture, there’s so much to yet we can learn from records of the past, particularly from other cultures, but it’s the internet and all of the required silicon manufacturing which makes dissemination of this possible… Standing in the present with an ear to the past and eye to the future! Once we move past the stage of memes (from fascination into a deeper understanding) there is so much room for individual, localized solutions, more than we can ever predict. But I suppose that until then we will need to rely on loaded terms to find such meeting places as this… and a fine one this is! A pity we cannot share a beer here, but I raise mine all the same!

The problem with intervention is that it takes longer to heal the effects of intervention. Say, a caesarean scar heals later… So does a episiotomy tear… I’m sad to read the chestnut tree chopping and the citrus tree cutting down. The scary thing we might have lost the few trees that fought the disease and were immune to that blight or bacteria..